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About the
Procedure
An
Overview
Typically, your contact (often an
email with questions answered) is followed by the
required phone preoperative discussion with the patient prior to
scheduling a surgery date. My practice is limited
to microscopic vasectomy reversal microsurgery. One
procedure is done daily on Tuesday and Thursday. I
perform two surgeries on Monday, Wednesday, and Friday. I will meet with you before
the procedure on the day of surgery. The
microsurgery is performed in the office operation room
under local anesthesia. Most patients stay at
a local motel overnight prior to resuming travel back
home the next day, although a two night stay is
ideally recommended.
Fee
Your total cost for the procedure
is $1,500. A $300 deposit is required in order to
secure a scheduled surgery appointment. (The
deposit is refunded at your request if you reschedule or cancel more
than 3 weeks before your appointment.) The balance
of $1,200 is to be paid by money order, cashier's check or cash on the
day of surgery. If you do not bring an insurance
prescription card, you will need approximately $35 for
prescriptions at the pharmacy on your day of surgery.
The
Surgery
You will shave the scrotum before
your appointment. You may have preoperative oral
sedation if you desire. After examination noting
testicular size, presence of epididymal fullness,
vasectomy site location, and length of distal vas
segment, local anesthetic (numbing medication) prepared
to be both quick acting and long in duration is placed
in the skin and soft tissues of the scrotum
using a very small, fine-tipped needle, less painful
than a pinch. After two or three small "pinches"
to instill the local anesthetic, the procedure is
painless for typical cases. It is not unusual for a
patient to doze during the procedure.
The surgery is performed with a
quality 3X to 23X magnification microscope. A
single one
inch incision is made in the skin for simple cases.
The area of scar and the vas ends are dissected.
The testicular end of the vas is divided at a level of
healthy tissue identified by high power magnification to
note the quality of the vas tissue and its blood supply.
A sample of vasal fluid is examined under a side table
microscope for presence of sperm. The findings are
noted, but vas-vas reconnection is planned even if no
sperm are seen, as this is the usual accepted practice.
The abdominal (upper) end of the vas is divided at a
level of normal appearing tissue above the scarred site
and gently flushed with saline. Every effort is
made to ensure a lack of tension on the anastamosis.
Quality titanium microsurgical
instruments are used to repair the vas. This is
done with a modified two layer technique as described in
the microsurgical literature. The modified inner layer
is performed using 9 zero nylon with a 100 micron
(4/1000th inch) diameter needle. The outer layer is
sutured with 8 zero nylon. An average of 14 total
sutures are placed in each vas, depending on the size of the two
ends. The sheath tissue around the vas is brought
together with suture to aid in
healing and blood supply.
A small rubber drain is placed and
the layers below the skin are closed with sutures that
absorb. The skin is also closed with fine
absorbable sutures. There are no sutures on the
outside, and no sutures to remove. For typical cases,
2 to 2.5 hours are needed to meticulously reverse what
was done in just a few minutes at the time of the
vasectomy.
Post
Operative Period
It is best if you can avoid travel
the day of the procedure. You will need to change
dressings at the drain site. You can simply remove
the drain or I may remove it the day following surgery.
Swelling and bruising up to twice normal size is
expected. The pain after surgery is the same as after
vasectomy in half of the patients. In a fourth of the
patients, the pain is less after reversal compared with
after vasectomy, and in the remaining quarter of
patients, the pain is worse after the reversal.
Advil or another medication is sufficient for discomfort
the first few days. Good scrotal support is key to
help relieve any
discomfort with standing.
Lifting over 30 pounds, running,
sports, or vigorous exercise is discouraged for three
weeks. Sexual abstinence is recommended for two
weeks. A
semen analysis is recommended at 4 months. I will
give you an order so the lab can fax results to me
and I can discuss the findings with you.
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